Veterans Affairs Secretary David Shulkin's chief of staff doctored an email and made false statements to create a pretext for taxpayers to cover expenses for the secretary's wife on a 10-day trip to Europe last summer, the agency's inspector general has found.

Vivieca Wright Simpson, VA's third-most senior official, altered language in an email from an aide coordinating the trip to make it appear that Shulkin was receiving an award from the Danish government - then used the award to justify paying for his wife's travel, Inspector General Michael Missal said in a report released Wednesday. VA paid $4,312 for her airfare.

The account of how the government paid travel expenses for the secretary's wife is one finding in an unsparing investigation that concluded that Shulkin and his staff misled agency ethics officials and the public about key details of the trip. Shulkin also improperly accepted a gift of tickets to a Wimbledon tennis match worth thousands of dollars, the investigation found, and directed an aide coordinating the trip to act as what the report called a "personal travel concierge" to him and his wife.

"Although the [inspector general's office] cannot determine the value VA gained from the Secretary and his delegation's three and a half days of meetings in Copenhagen and London at a cost of at least $122,334, the investigation revealed serious derelictions by VA personnel," the watchdog concluded.

Shulkin is one of five current and former Trump administration Cabinet members under investigation by agency inspectors general over their travel expenses, an issue that forced Tom Price to resign as Health and Human Services secretary in the fall. Shulkin and other Cabinet officials have said their travel, often on private and military planes or to speak at political events, was approved by agency ethics officials.

The Washington Post first raised questions about Shulkin's Europe trip - in particular the Wimbledon tickets and his wife's expenses - in a story in September.

In a response to Missal, Shulkin called his portrayal of the trip "overall and entirely inaccurate" and said it "reeks of an agenda."

"It is outrageous that you would portray my wife and me as attempting to take advantage of the government," he wrote.

Shulkin also wrote that VA staff suggested his wife's travel be paid by the agency and that he "had nothing to do with the process of obtaining approval." He delegated day-to-day trip planning to his staff, he wrote.

In an interview with investigators, Wright Simpson said she did not recall whether she altered the email, Missal wrote. In a second interview, he wrote, she did not directly respond to questions about the email, repeatedly saying "I responded appropriately to the email."

She did not immediately respond to messages seeking comment from The Post.

Shulkin, a physician and former hospital administrator who served as VA's undersecretary of health from July 2015 until last January, is the administration's lone holdover from the Obama administration. He leads the second-largest federal agency and is a favorite of President Donald Trump, who made improving care for veterans a centerpiece of his campaign.

On the trip to Europe last July, Shulkin and his wife, Merle Bari, were accompanied by Wright Simpson and Poonam Alaigh, then the acting undersecretary of health, as well as an aide and a six-person security detail. The group spent three-and-a-half days meeting with Danish and British officials to discuss veterans' health issues. Sightseeing occupied the other days, including tours of Westminster Abbey and Denmark's Rosenborg Castle, a cruise along the Thames and shopping in Sweden.

In September, in response to The Post's questions about the trip, VA issued a statement that said "all of Shulkin's activities on the Europe trip, including his attendance at Wimbledon, were reviewed and approved by ethics counsel."

That statement was not accurate, Missal found.

Before the trip, in response to a request from Shulkin, ethics officials reviewed only whether VA could pay his wife's expenses, Missal found. After The Post's inquiries, Shulkin asked for an expedited ethics review of the gift of Wimbledon tickets. When The Post story was published, ethics officials complained internally that VA's statement had misrepresented their role and cast them in a poor light, Missal wrote.

John Ullyot, VA's assistant secretary for public and intergovernmental affairs, told investigators that Shulkin dictated the language saying that all of his activities on the trip were reviewed, Missal wrote. Shulkin told investigators he had "no idea" where the statement originated.

In a separate response to Missal, private attorneys for Shulkin wrote that, "to the extent the statement could have been drafted more clearly, it is apparent that the statement was the result of haste, not an intentional effort to mislead."

In addition, at a Washington Post Live event in November, where he rebuked The Post for what he called "poor reporting," Shulkin said he had purchased the Wimbledon tickets, Missal wrote. Asked by a moderator if they were given to him "by folks from the Invictus Games or anything like that," Shulkin said they were not.

That statement also was not accurate, Missal found.

As he planned the trip, Shulkin contacted Victoria Gosling, chief executive for the 2016 Invictus Games, a sports tournament for wounded veterans founded by Prince Harry. Gosling was a strategic adviser to the games at the time, according to the report.

Gosling offered Shulkin two tickets and a grounds pass to the July 15 women's finals tennis match at Wimbledon, Missal wrote. She also treated Shulkin, Bari and their son to lunch before the match - which Venus Williams lost - in a private, members-only dining room. The tickets for the same match in the 2018 Wimbledon are selling for a minimum of $1,700 a piece, the report says, though Shulkin's attorneys said the tickets cost $450 in total.

In their response to Missal, Shulkin's attorneys wrote that the inspector general had misinterpreted his remarks.

As part of the review he sought after The Post's inquiries in September, Shulkin told an ethics official that Gosling and his wife were friends, Missal wrote. The official concluded that Shulkin could accept the tickets based on a "personal friendship" exception to rules prohibiting the acceptance of gifts, he wrote.

But the inspector general found the evidence of a friendship thin. When investigators interviewed Gosling last week, she could not recall Bari's first name, according to the report.

The findings were presented to the ethics official, who then reversed herself, concluding that "the documents totally indicate that they're not friends, as represented in [Secretary Shulkin's] response to me."

Shulkin told Missal's investigators he and his wife had offered to pay for the tickets before the trip, but that Gosling "insisted on taking us as friends," the report says.

Shulkin also told investigators he did not seek an ethics review before accepting the tickets because the tennis event "had absolutely no business connection whatsoever," the report says. "I wouldn't think about clearing it with ethics," Shulkin said.

In concluding that the gift was improper, Missal wrote: "Ms. Gosling gave a gift of the Wimbledon tickets, valued at thousands of dollars on the secondary commercial market, because of Secretary Shulkin's official position."

Shulkin's attorney said the secretary was not prohibited from accepting the tickets because Gosling neither does nor seeks to do business with Veterans Affairs.

Even so, they wrote that Gosling and Bari are friends and that Gosling attributed her failure to remember Bari's first name because she was pressure from investigators. "The investigators unexpectedly called me on my mobile phone whilst I was driving on a very busy highway," she wrote in a statement provided by the lawyers. "I felt like the investigators were twisting my words and trying to put words into my mouth."

Ethics officials initially declined the request to pay travel expenses for Bari, a Philadelphia-area dermatologist, "on the grounds that the available information did not show that her presence would serve a 'sufficient government interest,' " Missal wrote.

Wright Simpson, the chief of staff, became personally involved, Missal wrote. She pressed for Shulkin to receive an award from the Danish government, which she understood to be the criterion that would justify Bari's status as an "invitational traveler" whose expenses would be covered.

In emails to James "Gabe" Gough, the aide in the traveling party who was coordinating with VA's European counterparts, Wright Simpson pressed for confirmation of an award. Gough said no award was planned.

"We're working on having a dinner at the US Ambassador's Residence in the honor of SECVA, but that has not been confirmed by US Embassy Copenhagen yet," Gough wrote, using the acronym for the secretary of Veterans Affairs.

According to the report, Wright Simpson then altered the email to make it appear that Gough had written, "We're having a special recognition dinner at the US Ambassador's Residence in the honor of SECVA." With confirmation in hand, she told ethics officials that an award was definite. Bari was approved as an "invitational traveler," all expenses paid.

Shulkin received no award or special recognition on the trip.

Missal wrote that Wright Simpson's actions may have violated federal criminal statutes and that he referred the matter to the Justice Department. The Justice Department declined to prosecute, he wrote.

Once his wife was on the official list of participants, Shulkin directed Gough to coordinate with her to schedule meals and visits to tourist attractions. "Boss told me 'if she's happy, I'm happy and you're happy,' " Gough told a colleague in an email, according to the report.

Gough told investigators his involvement was necessary to coordinate security coverage for Shulkin.

Investigators came to a different conclusion: At Shulkin's direction and on official time, they wrote, "Mr. Gough was serving as a de facto personal travel concierge to the Secretary and his wife."

"Is there earlier flight from Copenhagen? Wimbledon tickets? High tea? Roman baths in [B]ath. Would want to do baths not just tour," Bari wrote to Gough in June.

In another email she said " . . . we like to be busy, we often don't spend too much time at palaces or cathedrals. Secretary agrees that need some time to check in with work answer emails or call back each weekday so can be flexible in later afternoon after we do sightseeing."

Gough complained to a colleague about Bari's many requests, writing, "I would have been finished with this a week ago."

The travelers' expenses in some cases were inadequately explained or poorly documented, investigators found. A member of the security team's expense voucher included "an inexplicable $3,825 overpayment for airport parking and a $2,718 overpayment for lodging."

Last-minute itinerary changes inflated airfare costs by $15,700, bringing the total to $42,230. Much of that covered an upgrade to business class on the return flight for Shulkin, who was suffering from back pain, and a member of his detail. Wright Simpson also modified her ticket to expand a 3½-hour layover by nearly two hours, a change that increased the price to $4,041 from $1,101.

The report mentions another unusual expense: VA had official "Trip Book" itineraries printed for the entourage, 15 copies at a cost of $100 each.

Authors information: Lisa Rein covers the federal workforce and issues that concern the management of government. The Washington Post's Alex Horton contributed to this report.